title: Inhaler mishandling remains common in real life and is associated with reduced disease control.
abstract: Proper inhaler technique is crucial for effective management of asthma and COPD. This multicentre, cross-sectional, observational study investigates the prevalence of inhaler mishandling in a large population of experienced patients referring to chest clinics; to analyze the variables associated with misuse and the relationship between inhaler handling and health-care resources use and disease control. We enrolled 1664 adult subjects (mean age 62 years) affected mostly by COPD (52%) and asthma (42%). Respectively, 843 and 1113 patients were using MDIs and DPIs at home; of the latter, the users of Aerolizer®, Diskus®, HandiHaler® and Turbuhaler® were 82, 467, 505 and 361. We have a total of 2288 records of inhaler technique. Critical mistakes were widely distributed among users of all the inhalers, ranging from 12% for MDIs, 35% for Diskus® and HandiHaler® and 44% for Turbuhaler®. Independently of the inhaler, we found the strongest association between inhaler misuse and older age (p = 0.008), lower schooling (p = 0.001) and lack of instruction received for inhaler technique by health caregivers (p < 0.001). Inhaler misuse was associated with increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), courses of oral steroids (p < 0.001) and antimicrobials (p < 0.001) and poor disease control evaluated as an ACT score for the asthmatics (p < 0.0001) and the whole population (p < 0.0001). We conclude that inhaler mishandling continues to be common in experienced outpatients referring to chest clinics and associated with increased unscheduled health-care resource use and poor clinical control. Instruction by health caregivers is the only modifiable factor useful for reducing inhaler mishandling.
authors.affiliation: Fisiopatologia e Riabilitazione Respiratoria, Policlinico Le Scotte, Azienda Ospedaliera Senese, Siena, Italy. a.melani@ao-siena.toscana.it
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Melani
authors.forename: Marco
authors.initials: M
authors.lastname: Bonavia
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cilenti
authors.forename: Cristina
authors.initials: C
authors.lastname: Cinti
authors.forename: Marco
authors.initials: M
authors.lastname: Lodi
authors.forename: Paola
authors.initials: P
authors.lastname: Martucci
authors.forename: Maria
authors.initials: M
authors.lastname: Serra
authors.forename: Nicola
authors.initials: N
authors.lastname: Scichilone
authors.forename: Piersante
authors.initials: P
authors.lastname: Sestini
authors.forename: Maria
authors.initials: M
authors.lastname: Aliani
authors.forename: Margherita
authors.initials: M
authors.lastname: Neri
mesh_terms: D000280:Administration, Inhalation; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D036501:Metered Dose Inhalers; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000523:psychology; D012648:Self Care